Or. Admin. Code § 309-040-0355 - Contracts

(1) Providers who care for residents who are or become eligible for Medicaid services must enter into a Medicaid Provider Enrollment Agreement with the Division and comply with Division rules and terms governing provider participation in the Oregon Medicaid program. Applicable Division rules in addition to these rules include, but are not limited to:

(a) OAR 407-120;

(b) OAR 410-120;

(c) OAR 410-172;

(d) OAR 410-173; and

(e) OAR 943-120.

(2) Providers must be qualified, professionally competent and actively licensed where required by law to perform work under the Medicaid Provider Enrollment Agreement.

(3) The rate established by the Division is considered payment in full. The licensee may not request or accept additional funds or in-kind payment from any source.

(4) An approved Medicaid provider enrollment agreement is valid so long as the license remains valid unless earlier terminated by the provider or the Division.

(5) The Division may terminate a Medicaid provider enrollment agreement under the following circumstances:

(a) The provider fails to maintain substantial compliance with all related federal, state and local laws, ordinances and regulations; or

(b) The license to operate the adult foster home has been voluntarily surrendered, revoked or non-renewed.

(6) The Division must terminate a Medicaid provider enrollment agreement under the following circumstances:

(a) The provider fails to permit access by the Department, the local licensing authority or the Centers for Medicare and Medicaid Services to any adult foster home licensed to and operated by the provider;

(b) The provider submits false or inaccurate information;

(c) Any person with five percent or greater direct or indirect ownership interest in the adult foster home did not submit timely and accurate information on the Medicaid provider enrollment agreement form or fails to submit fingerprints if required under OAR 407-007-0200 to 407-007-0370;

(d) Any person with five percent or greater direct or indirect ownership interest in the adult foster home has been convicted of a criminal offense related to the person's involvement with Medicare, Medicaid or title XXI programs in the last 10 years; or

(e) Any person with an ownership or control interest or who is an agent or managing employee of the adult foster home fails to submit timely and accurate information on the Medicaid provider enrollment agreement form.

(7) If the provider submits notice of termination of the Medicaid provider enrollment agreement, the provider must concurrently issue the Division's Notice of Involuntary Move, Transfer or Discharge of Resident form to each resident eligible for Medicaid services residing in the AFH and must issue written notification to all residents who pay with private funds. Provider must also immediately update the house policies.

(8) If either the provider or the Division terminates the Medicaid provider enrollment agreement, a new Medicaid provider enrollment agreement will not be approved for a period of no less than 180 days.

Notes

Or. Admin. Code § 309-040-0355

MHD 19-1985(Temp), f. & ef. 12-27-85; MHD 6-1986, f. & ef. 7-2-86; MHD 1-1992, f. & cert. ef. 1-7-92 (and corrected 1-31-92); MHD 6-1999, f. 8-24-99, cert. ef. 8-26-99; Renumbered from 309-040-0040, MHD 3-2005, f. & cert. ef. 4-1-05; MHS 14-2016(Temp), f. 9-6-16, cert. ef. 9-7-16 thru 3-3-17; MHS 3-2017(Temp), f. 3-3-17, cert. ef. 3-4-17 thru 8- 30-17; MHS 9-2017, f. 6-29-17, cert. ef. 7/1/2017; BHS 5-2025, amend filed 02/28/2025, effective 3/1/2025

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 443.705 - 443.825